As US measles cases top 100, Toronto reports 4 infections

California officials today said they have confirmed 92 measles cases since December, 59 of which are linked to visiting Disneyland, bringing the US total to more than 100 cases, while Toronto has confirmed 4 cases not linked to each other or to travel outside the country.

The update today from the California Department of Public Health (CDPH) includes one new case since the agency's previous update on Jan 30, in a child under 1 year old. Of the 59 cases linked to Disneyland, 40 involved people who likely contracted the disease in the park, and 19 cases involve contact with one or more of those primary cases—or with someone who had contact with a primary case.

Establishing the exact number of outbreak-related US cases is difficult. The US Centers for Disease Control and Prevention (CDC) updated its total to 102 on Jan 30 in 14 states. Those numbers, however, include only cases since Jan 1, and it's unclear how many of them are from California, because the CDC has not yet provided a state-by-state breakdown.

The CDPH last reported Disney-linked measles cases in other states on Jan 28, at which point there were 13 in six states, plus a case in Michigan that was linked to travel to California but not to Disneyland. Some of those illnesses began before Jan 1. The CDC said that 92% of its 102 confirmed cases—94 cases—are linked to the Disney outbreak.

In Toronto, meanwhile, Toronto Public Health (TPH) said the four lab-confirmed cases involve two children under 2 years old and two adults, all from different families. "No source case has yet been identified and there are no known links or contact between the cases," TPH said in a news release today.

The agency said it is following up with known contacts and anyone else who might have been exposed. A Toronto Globe and Mail story today said that none of the patients traveled recently outside the country.Feb 2 CDPH update Jan 30 CDC update Feb 2 TPH news release Feb 2 Globe and Mailstory

Saudi Arabia, Qatar report MERS cases

Officials announced a case of MERS-CoV in Qatar over the weekend, and Saudi Arabia's Ministry of Health (MOH) reported a new case today.

The case of MERS-CoV (Middle East respiratory syndrome coronavirus) in Qatar involves a 55-year-old man who was hospitalized with fever and joint pain. Qatar's Supreme Council of Health is screening the man's close contacts for symptoms and reinforcing infection control practices in hospitals, the agency said.

The new case, the country's first of 2015, brings Qatar's MERS-CoV total to 12.

The Saudi case-patient reported today is a 62-year-old man from Hafoof who is in stable condition. The man has an underlying medical condition and had contact with MERs cases in the community. He did not have recent exposure to animals or to MERS patients in clinical settings, and he is not a healthcare worker.

The Saudi MOH also reported a MERS-CoV death yesterday in an 80-year-old man from Riyadh whose case was previously reported. The man had an underlying health condition and was not a healthcare worker.

Chikungunya cases rise by more than 14,000 in Colombia

The Pan American Health Organization (PAHO) reported 19,668 new cases of chikungunya in the Caribbean and Americas on Jan 30, and more than 14,000 cases occurred in Colombia, bringing the outbreak total to 1,182,857.

The new total includes 1,155,354 suspected and 24,521 confirmed locally acquired cases and 2,982 imported cases of chikungunya. Colombia reported 14,009 new cases, bringing the country's outbreak total to 127,370.

Other areas with substantial increases in case numbers over the previous week include El Salvador, which reported 2,272 new cases, and French Guiana, with 2,209 new cases. The countries' outbreak totals are 137,655 and 16,279 cases, respectively.

PAHO also reported 3 new deaths related to chikungunya, all of which occurred in Puerto Rico, bringing the territory's death total to 13. The outbreak fatality total is now 179.Jan 30 PAHO report

Two H7N9 infections reported in China, 1 fatal

China's Guangdong province has reported two more H7N9 avian flu infections, in a 48-year-old man who died from his illness and a 9-year-old girl, Hong Kong's Centre for Health Protection (CHP) said in a Jan 31 statement.

The patients are from two different cities, the man from Jieyang and the girl from Shanwei. The CHP said the girl is hospitalized in stable condition.

The new infections lift the global H7N9 case total to 541 cases, according to a case list maintained by FluTrackers, an infectious disease news message board.Jan 31 CHP statement FluTrackers H7N9 case list

Meanwhile, the World Health Organization (WHO) yesterday confirmed two Canadian H7N9 cases that were previously reported by Canadian officials and involve a wife and husband from British Columbia. The two developed their illnesses after returning from travel in China, where they were exposed to live poultry.

The woman got sick on Jan 14 and first saw a physician the next day. She was placed on antiviral therapy after initial tests were positive for influenza A. Additional tests confirmed H7N9 on Jan 26.

Her husband, who has underlying medical conditions, started having symptoms on Jan 13 and sought care the same day. On Jan 19 he was prescribed antiviral medication, and tests confirmed his H7N9 infection on Jan 29. Neither patient was hospitalized, and both have recovered; they have agreed to self-isolate.Feb 1 WHO statement

Cholera declined overall during 2014 in Haiti, Dominican Republic

Both Haiti and neighboring Dominican Republic reported big overall declines in cholera cases in 2014 compared with 2013, but both countries had increases late in the year, according to a Jan 30 update from PAHO.

Haiti had 27,753 cholera cases and 296 deaths in 2014, which represented decreases of 53% and 50% from the previous year's levels, PAHO reported. But weekly cases were sharply higher in the fall than in the rest of the year.

From weeks 37 to 47, or about mid-September to late November, the average weekly count was 918 cases, versus a weekly average of 251 cases for the first 36 weeks of the year, the report said. Cases dropped in December.

Haiti has been battling cholera since the fall of 2010. Investigators concluded that United Nations peacekeepers from Nepal inadvertently brought the pathogen into the country.

The Dominican Republic reported a total of 597 suspected cholera cases for the year, with 10 deaths, PAHO reported. That was a 69.5% drop in cases and a 76% decline in deaths from the 2013 numbers.

Through most of the year the country had only a few cases per week, but the numbers surged from weeks 46 through 49, or early November to early December. Week 48 brought more than 130 cases, according to a PAHO graph.

In other observations, the update said Mexico had 14 cholera cases last year, 13 of them in the state of Hidalgo.

Also, in early January Canada reported a cholera case in a person who had recently traveled to Cuba, PAHO reported. Cuban authorities were investigating the source of the infection. Jan 30 PAHO update

Study finds no safety concerns over MMR vaccine in adults

A federal study reported in Clinical Infectious Diseases found no new or unexpected safety concerns over administering the measles, mumps, and rubella (MMR) vaccine in adults.

The review covered 3,175 reports of events after MMR vaccination logged in the Vaccine Adverse Event Reporting System (VAERS) database from Jan 1, 2003, through Jul 31, 2013. It was conducted by scientists from the CDC and the Food and Drug Administration.

Of those events, 168 (5.3%) were classified as serious, including 7 deaths. The most common signs and symptoms for all reports—serious and not—were fever (19%), rash (17%), pain (13%), and joint pain (13%).

The authors also noted that at least 131 pregnant women received the MMR vaccine even though it is contraindicated for this group. Most of the women received the vaccine during their first trimester, and 38% reported at least one adverse event.

The investigators wrote, "We did not detect any new or unexpected safety concerns for MMR vaccination in adults." They added that the finding of vaccination in pregnant women indicates a need for provider education.Jan 30 Clin Infect Disabstract